This chapter explores the application of critical thinking, nursing process, and current evidence as a foundation for informed, safe, and professional nursing practice. The American Nurses Association (ANA) Standards provide the framework necessary for critical thinking in the application of the nursing process. The nature of evidence-based practice, its relevance to nursing, and the skills needed to support it are essential components of baccalaureate nursing education, all of which lead to the development of independent, self-directed learners, and, ultimately, professional nurses. Evidence-based nursing is the practice of making clinical decisions based on the best available current research evidence, clinical expertise, and the needs and preferences of the client. According to guidelines from The Joint Commission (TJC), the care planning process is the structural framework for coordinating communication that will result in safe and effective care.
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This book is a response that fosters education, practice development, and professionalism. The bachelor of science in nursing (BSN) is the essential educational foundation to give nurses the knowledge to improve health outcomes and provide the highest quality care. It provides the essentials of nursing theory and the importance of having a philosophy of nursing that informs our professional role. The book is written to assist with the transition from the role of the LPN to the baccalaureate-prepared registered nurse (RN). Licensed practical nurses (LPNs) who enter a university to advance their education through seeking a baccalaureate of nursing degree often find the experience of socializing into the new professional role challenging. The book analyzes the change process, discusses Benner’s stages of clinical competence, examines the philosophy of nursing and describes stress reduction measures. The terms leadership and management are described, and the role of the baccalaureate-prepared nurse as leader and manager is explored. Finally the book talks about the Skill Competencies required for the Baccalaureate-Prepared Nurse-electronic health records (EHRs); the Technology Informatics Guiding Education Reform (TIGER) Movement; Simulated E-Health Delivery System (SEEDS) and Nursing Informatics Education Model (NIEM). The Quality and Safety Education for Nurses (QSEN) program was created in 2005 by an expert panel of nursing educators with the aim of preparing future nurses to continuously advance the quality and safety of the health care system in which they practice. The group developed six core competencies to be incorporated into nursing curricula: client-centered care; teamwork and collaboration; evidence-based practice; quality improvement; safety; and informatics.
This chapter presents two evidence-based practice (EBP) scenarios that illustrate how implementation of EBP requires an interprofessional collaborative team approach and a well-designed implementation plan. Nurses are at the heart of implementing EBP, and when they do not have team support, collaboration, and a well-thought-out implementation plan, success of an EBP project is unlikely. The chapter provides a review of fundamental concepts and strategies that must be considered with any model when implementing EBP projects. While not detracting from EBP models, the chapter provides suggestions and reminders for selecting key implementation strategies. EBP is becoming the standard for delivery of the best and most up-to-date patient-centered care. Undoubtedly, EBP implementation strategies are becoming a necessary component of the nurse's repertoire for the delivery of optimal care. The chapter outlines useful approaches to EBP implementation spanning from the inception of an EBP idea to the dissemination of the final EBP product.
This chapter explores inductive and deductive approaches to understanding nursing phenomena and addresses the concepts and propositions that comprise nursing theory. It illustrates the use of concept mapping as a tool to clarify meaning and linkages among concepts, and describes middle range theories of particular use to nursing as integral to evidence-based practice (EBP). The chapter then presents criteria for analysis of theory, and a real-world example describing how a nursing phenomenon was initially considered and then used during the research process to advance EBP. Theory helps nurses understand the conceptual components of interventions, including how interventions are effective and facilitate clarification of conflicting findings. To be most effective, theories must be realistic and provide evidence of benefit to patients and families. Selecting theories for application are decisions that require evaluation, including analysis of a theory's value, worth, and significance.
Nurses who engage in evidence-based practice (EBP) report heightened motivation, autonomy, and clinical expertise. Empowered nurses are generally employed in healthy work environments that provide organizational structure for participant empowerment. Healthy work environments manifest attributes of interprofessional collaboration, effective communication, accountability, shared clinical decision making, and visible, dependable organizational leadership. Nurses working in healthy organizations often report a greater sense of empowerment. This chapter describes ways nurses are expected to act when empowered to solve patient care problems and promote positive healthcare decisions. It reviews how empowered nurses birth new ideas and innovations and engage in EBP to contribute and utilize new knowledge for the advancement of patient care. The chapter emphasizes how nursing leadership and those who practice professional nursing are responsible for setting up cultures of care that empower nurses to engage in EBP.
This chapter helps the reader to explain the significance of clinical practice guidelines (CPGs), describe the relationship between CPGs and evidence-based practice (EBP) and to describe the Institute of Medicine (IOM) standards for CPG development. It also helps the reader to discuss CPG appraisal and implementation and identify factors that promote or inhibit CPG adoption. Nurses are demonstrating commitment to EBP and the most effective methods for translating appropriate evidence into a clinical context. CPGs are an effective method to facilitate appropriate patient-centered care based on best evidence and broad expert consensus. The nurse and healthcare organization deciding to use a guideline must ensure the CPG was developed appropriately using a standardized and acceptable methodology. By understanding the factors that influence adoption and utilization of a CPG, better planning for implementation in the clinical setting can occur.
This chapter helps the reader to identify characteristics of formal and informal leaders, describe ways nursing leaders encourage an organizational spirit of patient-centered inquiry and to outline a plan for implementing an evidence-based practice (EBP) healthcare culture. It addresses the roles of formal and informal leaders in developing and sustaining an organizational culture of EBP. Healthcare settings with an embedded EBP culture demonstrate the EBP process as normative and expected behavior of nurses' everyday work life. Effective nurse leaders understand the organization's overall purpose and goals for establishing an EBP culture. Nurse leaders are clear about the needs of the organization's participants to help EBP grow and thrive as a means of delivering high-quality patient care. The chapter highlights ongoing strategies that effective nurse leaders use to attain and uphold an EBP culture. It explores the underreported, yet vitally important, role that informal leaders have in fostering an EBP culture.
This chapter focuses on systematically developing a clinical question so that each component of the question is clear. Clinical questions are the indisputable driving force behind evidence-based practice (EBP), and without questions EBP would be unnecessary. The chapter presents the mnemonic PICOT (patient population, intervention, comparison, outcome, time frame), along with several opportunities to explore sample clinical questions that are under development and that are well written. It discusses the role of PICOT-digital data (PICOT-D) for nurses educated at the doctor of nursing practice level. Reflecting on the scope of the clinical questions presented as samples in the chapter exemplifies that PICOT can be applied in any nurse-patient interaction to improve patient outcomes. Patients can potentially benefit from direct care nurses being well versed in EBP. Nurses who are skilled at writing PICOT questions have a positive impact on patient outcomes, such as quality of life, satisfaction, and safety.
This chapter provides an overview of planned change management to facilitate implementation of evidence-based practice (EBP) in the clinical setting. It presents two change scenarios. In Scenario 1, implementation of practice change related to interprofessional simulation was ultimately unsuccessful. In contrast, Scenario 2 illustrates a successful practice change initiative in which the approach to the proposed initiative was deliberate and systematic to ensure adoption in a dynamic and demanding practice environment. Lewin's three-step change model and force field analysis along with Kotter's change management principles frame the discussion about this EBP organizational initiative. Using change theory to guide systematic implementation of EBP helps bridge the research-practice gap by providing a guiding framework to implement and achieve sustained change. Participation of staff in the change effort from the onset as well as maintaining open and ongoing communication throughout the change process are essential to minimize resistance and promote sustainable, permanent change.
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This chapter presents two evidence-based practice (EBP) scenarios that depict how the success of a project can be impacted by external and internal organizational pressures. Understanding an organization's priorities and strategic goals is paramount in the success of projects, whether large or small. Applying evidence to a practice change focuses on improving processes that will lead to desired outcomes. Continuous improvement of the systems and processes is achieved through use of the plan-do-study-act (PDSA) cycle. These strategies are the foundation of modern-day quality improvement. A number of factors contribute to developing a high-reliability healthcare organization. These factors include leadership commitment, effective communication, interdisciplinary teamwork, standardized processes, and a structure for process improvement. EBP supports standardized practice, which leads to decreased cost and improved patient outcomes. EBP projects should align with organizational goals and be inclusive of all stakeholders in defining the problem as well as creating the solution.